In addition, the hospital, in a press release on Wednesday, said it seeks any and all information regarding the process Anthem used to decide which hospitals would be allowed into the narrow network and which ones would be excluded.

Nine New Hampshire hospitals have been blocked from joining the ACA narrow network.

The legal action was filed with the N.H. Department of Insurance.

“This is the worst thing I have ever seen,” says Frisbie Memorial Hospital CEO Alvin Felgar, referring to the exclusion of his hospital from Anthem’s network of providers. In almost 40 years in the medical business — 21 of them at Frisbie — Felgar has seen a lot, and he is at a loss as to why nine New Hampshire hospitals, including his own, have been cut out of providing services under the Affordable Care Act.

Under the ACA, popularly known as ObamaCare, patients with no health insurance are being required to enroll in the Health Insurance Exchange, also known as the State Insurance Marketplace. In New Hampshire, the only carrier that has joined the marketplace so far is Anthem Blue Cross Blue Shield, which chose not to include Frisbie Memorial Hospital, and nine other hospitals across the state, as part of its network of providers.

Starting Jan. 1, 2014, patients with individual health insurance under the ACA will not be covered at Frisbie — or the other eight New Hampshire hospitals excluded from the network — unless they are receiving emergency medical care.

As it now stands, as many as 7,000 people — about 20 percent of Frisbie’s patients — if they choose to become part of the exchange, as required by law, will have to go to other providers for treatment. They will also need to find new doctors who are part of the new Anthem network. Included in this narrower network of providers, locally, are Wentworth-Douglass Hospital, Exeter Hospital and Huggins Hospital in Wolfeboro, but neither Frisbie nor Portsmouth Regional Hospital.

“This is starting to sink in with people,” Felgar said.

Medicaid and Medicare patients, and those people with group plans through their employment, will not be affected, although Felgar fears, in the case of employers’ plans, that this could change.

“If Anthem continues to apply the narrow network, it will hurt Frisbie. There is a critical number of patients needed to be efficient. We have got to be ready to take emergency calls, and we will certainly do that, but it is galling to lose bread and butter patients,” Felgar said.

Already he has knowledge of people with individual plans being impacted.

“One of the officers of the medical staff of Frisbie got a notice from Anthem canceling her plan. Now she has to go to Wentworth-Douglass,” said Felgar.

Felgar is particularly galled at Frisbie’s exclusion from the network, because the hospital is a high quality, low cost facility. A fact sheet being distributed makes the following points:

■ Federal Government: FMH charges 22 percent less than all other Seacoast hospitals.

The lack of competition, leading to Anthem’s monopoly position in NH’s Affordable Care Act program, Felgar believes, can be traced back to a change in the state’s underwriting rules, a few years ago — changes signed into law by then Gov. Jeanne Shaheen.

“That seems to have been a milestone,” said Felgar, noting that before that time there had been six or eight health insurance companies operating in New Hampshire. Since then, there has been an exodus.

“Now, only one insurance company’s plans are offered. There is no price competition — more companies in the Insurance Exchange would help. And, providers were not given the opportunity to compete on price. Anthem excluded 10 hospitals and their doctor networks without ever discussing their interest in participating or pricing,” said Felgar.

More insurance companies would mean they would have to compete to sell their products to employers. In order to compete, they would need to lower the premiums, Felgar pointed out.

“Anthem has never talked to Frisbie, and still won’t talk about it,” he continued. “So how does a monopoly operate without getting bids from providers? It doesn’t add up. I told Anthem I would accept the same terms as Wentworth-Douglass Hospital. Lisa Guertin (NH president of Anthem) wouldn’t do it. The way this has been implemented is totally unlike anything I have ever seen in this state — no due process, no public hearings, limiting patient choice — and the insurance commissioner signed off on it.”

The Concord Monitor, covering a meeting between Guertin and state senators in September, reported that the CEO said Anthem sought to reduce the cost of its plans by reducing the number of participating providers, with participating hospitals accepting lower reimbursement rates to gain patient volume in a narrow network.

Felgar, according to the Monitor, told the senators that Anthem’s representatives wouldn’t even speak with the hospital’s leaders about participating in the network.

Anthem isn’t likely to add more hospitals to the network, Guertin said, according to the Monitor, given the hospitals participating now were persuaded to accept lower reimbursement rates in large part by the promise of getting more patients in a narrow network.

Sen. Sam Cataldo, a Republican whose District 6 constituency includes Rochester, had knee surgery this summer, and pointed out to Guertin that the only two New Hampshire hospitals that provide that service aren’t included in the narrow network.

“You’re not helping at all, the stuff I’m looking at, as far as these knees, anybody’s knees,” he said. “You picked and (chose), and I don’t like that at all.”

Guertin is quoted as saying, “I understand it’s imperfect. It isn’t perfect. But I do believe it’s in the greater good.”

Cataldo, contacted by the Rochester Times, said, “There is a growing awareness that the new health care delivery system runs the risk of negatively affecting peoples lives. I remain supportive and committed to making sure that patients understand the new challenges facing them under the Affording Care Act (ACA) regulation and to help ensure they can continue to access the same high quality care they’ve always received in New Hampshire.

“I commend Frisbie Memorial Hospital and the other hospitals for the work they are doing to educate patients about changes in how they receive their health care. I shall, as your N.H. state senator, continue to pay close attention to the impacts of the ACA, and will work to make available more health insurance companies, to protect our community, taxpayers and patients.”

Felgar, speaking from his Frisbie office last week, said he is exploring his legal options and working with N.H. Senate and House members, to see what can be done to remedy the situation.

“We want the state to tell Anthem to sit down with Frisbie Memorial Hospital in good faith and negotiate the same deal (as WDH),” he said. “We are a high-quality, low-cost provider.”

Vice Chair of Frisbie board of trustees Ron Poulin is also on the N.H. Auto Dealers Association Services Board.

Wearing his second hat, he said “We shop around for insurance every year, and there is increase after increase. There is not enough competition.”

Meanwhile, said Poulin, insurance companies are paying providers less in reimbursements.

“They are working both angles,” he said. “We have to create more marketplace competition. Maybe some laws have to be changed or rewritten to facilitate that.”

The alternative, he said, was the potential for the situation to get even worse.

Poulin continued, “Al’s doing a tremendous job. He is standing up for everyone in the state on this. Some of the others lack courage.”

Felgar said that he had also contacted N.H.’s state delegation — U.S. Sens. Kelly Ayotte and Jeanne Shaheen, and Congresswomen Ann McLane Kuster and Carol Shea-Porter.

Ayotte and Shaheen staff members “expressed concern,” said Felgar, while nothing was heard from Kuster.

“Carol Shea-Porter has been very helpful, making inquiries at federal and state level,” said Felgar.

Shea-Porter’s Communications Director, Ben Wanaka, contacted in Washington D.C., said, “Following news that only Anthem would offer plans through the Marketplace in 2014, the congresswoman spoke directly to President Obama about New Hampshire’s single health insurer and N.H.’s historically high costs. She has continued to advocate for the state in follow-up conversations with various administration officials. On Wednesday (Oct. 30), she spoke again with White House Chief of Staff Denis McDonough about Anthem’s decision not to include some hospitals and doctors in its narrow network.

“She has been talking with Al Felgar, local elected officials, and other hospital administrators about Anthem’s decision to offer a narrow network on the Marketplace because she knows how important it is to increase competition in New Hampshire and expand network options for Granite State families. She has also urged federal agencies to perform stringent oversight to ensure New Hampshire residents are getting the best, most affordable care.

Contacted through her congressional office, Shea-Porter said, “I’ve been disappointed with the rollout of the Affordable Care Act and the fact that there is currently only one insurance company in New Hampshire’s Marketplace and they are offering a narrow network of hospitals and doctors. I’ll continue to focus on increasing insurance competition in New Hampshire and driving down costs for Granite Staters.

“I appreciate Anthem’s new informational letter that ensures Granite Staters who currently have individual market insurance policies from Anthem will have the choice to renew that coverage by Nov. 15 and keep their current hospital network and doctors, or enroll in the ACA Marketplace that will offer quality, affordable health care.

“For the vast majority of New Hampshire consumers who currently have employer-sponsored insurance, Medicare, Medicaid, or VA care, they can look forward to going to the same doctors and hospitals next year, but with the added benefits that come with the Affordable Care Act.”

She-Porter continued, “Under the Affordable Care Act, the prescription drug doughnut hole is closing for seniors; women are no longer discriminated against because of their gender; young adults can stay on their parents’ insurance until they’re 26; all Americans have access to a range of preventive care; and no one can be denied care due to pre-existing conditions. While I’m pleased with the many consumer friendly provisions, more needs to be done to drive down deductibles and premiums and increase insurance competition so everyone in our state has access to quality, affordable health insurance.”

One ray of hope is that Harvard Pilgrim Health Care, according to Felgar, has expressed an interest in joining the Health Insurance Exchange in 2015.

Meanwhile, he encourages greater Rochester area residents to contact their state representatives and senators and tell them that Frisbie Memorial Hospital should be allowed in the network. Support can also be expressed by calling 335-8100 or emailing bigal@fmhospital.com.

According to an Associated Press report Thursday afternoon, the New Hampshire Insurance Department will hold a public hearing to address Felgar’s concerns about being excluded from the network of providers for those purchasing individual health insurance plans under the federal health overhaul.